Quick question: how did you sleep last night?

See if you fit into any of these statistics: 50-70 million Americans have a sleep disorder. 25 million Americans have sleep apnea. 37% of 29-35 year-olds sleep less than eight hours per night. 40% of 40-59 year-olds sleep less than eight hours per night. 35% of American adults sleep even less than 7 hours per night. It’s a bad situation.

Some scary effects of too little sleep. 38% of Americans report unintentionally falling asleep at least once a month. Almost 5% of Americans report falling asleep at the wheel (that’s bananas; think about it – one out of 20 cars you see could have a driver who is nodding off). Of the 100,000 deaths that occur in U.S. hospitals due to medical error, doctors being sleep deprived is considered to be very often an influencing factor – though it’s pretty hard to measure how much or little of those deaths could directly be linked to sleep deprivation.

What’s much less discussed is how this is connected to hormone imbalances. What happens with your hormones when you sleep? How do your hormone levels and function affect your sleep? And how can you use that information to get good sleep?

The regulation of hormones during sleep

For example, you make more human growth hormone (HGH) when you sleep. This is partially responsible for your body’s ability to heal from an injury. So if you need to heal, you need to sleep. It also affects muscle growth, so if you’re trying to bulk up, get some more sleep in addition to your workout. Cortisol production slows when you sleep. Cortisol contributes in a huge way to fat storage and weight gain. If you’re trying to lose weight, you need to sleep.

Interestingly, TSH (thyroid-stimulating-hormone) is released in higher doses in the late evening—when you should be sleeping, but many of you aren’t. It is released regardless of whether or not you are sleeping. This blunts the effects of the hormone because it wants to go to work on a sleeping body. Melatonin – the hormone that regulates feeling awake or sleepy – is released when it gets dark at nighttime and is not released when your environment is bright.

The dis-regulation of hormones with lack of sleep

Lets say you get 4-6 hours a sleep regularly, for say, six months or a year. What does that do to your hormones?

After even one week of sleep deprivation, your cells become glucose intolerant, meaning they no longer recognize glucose floating around in your bloodstream and pull it in for use as fuel. This is, in essence, tiredness. Simply NOT sleeping doesn’t make you exhausted. What makes you exhausted is your cells basically deciding not to use the energy that’s floating around all around them in the form of glucose. You have no energy in your cells.

Lack of sleep also increases insulin resistance. In fact, only one night of sleep deprivation reduces insulin sensitivity (how willing your cells’ receptors accept insulin) by 33% according to a 2015 study released by Ceders-Sinai Medical Center.

These two related facts show why Adults who report getting 5 or fewer hours of sleep a night were 2.5 times more likely to have diabetes, compared to people who sleep 7 – 8 hours per night. People who slept 6 hours/night were 1.7 times more likely to have diabetes than their peers who sleep longer. Interestingly, people who sleep for 9 or more hours also have higher rates of diabetes, so perhaps both insufficient sleep and too much sleep are both unhealthy when it comes to insulin and the development of diabetes.

Now, those who sleep less are also, generally speaking, more likely to be overweight or obese. A lot of this is due to the fact that cortisol slows down while you’re sleeping (cortisol signals the storage of fat). So the less you sleep, the more time during the day your body is releasing cortisol, and the more signals your body is getting to store fat.

But there are two other hormones related to weight and sleep: leptin and ghrelin. Leptin lowers your appetite. Ghrelin increases your sense of being hungry. I think of it like this: Leptin starts with “L” and it “Lowers” your appetite. Lower starts with “L”. Ghrelin starts with “G” and it makes your appetite “greater,” which starts with “G”. It’s important to make the distinction as they basically work in opposition to each other and you can’t talk about one without the other.

If you are sleep deprived, leptin production slows and ghrelin production increases. This means, regardless of how much or when you eat, you still feel hungry. The less sleep you have, the greater your sense of hunger. And here’s a twist, for reasons not completely known, it is documented that people tend to crave sweets and carbs and salty snacks later at night.

So, between insulin resistance, glucose intolerance, more cortisol signaling fat storage and your leptin/ghrelin levels making you feel hungry all the time, sleep deprivation is about as close to a guarantee you’re going to get that you are on the road to obesity and diabetes—if you’re not already there.

Get some sleep!

American culture, in some ways, glorifies being sleep deprived. Our college students brag about how they slept 8 hours a week during finals. Doctors and paramedics are required to do 12 or 24-hour shifts. The guy who works 80 hours a week is somehow a hero. It’s silly, and I’m hoping knowledge about how sleep deprivation is just terrible for you health can help to change that.

But there are some of you reading right now thinking, “Doc, I’d love to get more sleep, but I just can’t. I lay there and my mind races and I toss and turn and nothing happens.” I get that. And I’m here to tell you it’s very likely also related to hormones—even though that’s really not the root cause. According to a 2005 study in the Journal of Clinical Endocrinol Metabolism, insomnia is very often the result of an overactive and over-stressed hypothalamic-pituitary-adrenal (HPA) axis. These three glands (hypothalamus and pituitary in the brain and adrenal above the kidneys) have a lot to do with the secretion—or lack thereof—of hormones.

But what stresses out these three important glands? STRESS! Always being on the go, always worrying, constant anticipation, rushing, meeting deadlines, making sure the kids get to baseball games on time, or that dinner is on the table at a certain time, or that the house is spotless, or that your boss gets that report, or that there’s not enough money.

Sadly, I can’t tell you how to fix these problems. I can tell you some very helpful tricks on managing and reducing your stress though.

Get into meditation. There are guided meditation all over YouTube. There are websites like calm.com. There are books. There are studies. A 2016 literature review of 47 meditation studies in the Journal of the American Medical Association found it useful in most participants in reducing stress, anxiety and depression.

Beyond that, spend more time doing things you enjoy. I bet there are hobbies you’ve given up on in favor of—let’s be frank—pleasing the other people in your life. Take more time for yourself. Get more exercise because (another hormonal effect), endorphins released during exercise make you feel happier and reduce stress and worry.

One double-blind study published in 2011 in the Journal of Physics that investigated the effects of earthing on 58 healthy adults used conductive adhesive patches placed on the sole of each participant’s foot to read their electrical signals. The subjects were exposed to 28 minutes in the unearthed condition followed by 28 minutes with the earthing wire connected. Controls were unearthed for 56 minutes.

After earthing, about half the subjects showed “an abrupt, almost instantaneous change in root mean square (rms) values of electroencephalograms (EEGs) from the left hemisphere of the brain.” These changes are believed to signify positive changes and lower stress reactions. Nineteen of 22 earthing participants also experienced decreased blood volume pulses (BVP). After considering the effects on electrophysiological properties of the brain and musculature as recorded using EEG, EMG and BVP readings, the findings suggest significantly higher reductions in overall stress levels and tensions results in the earthing participant’s compared to the control group.

The importance of melatonin

Now lets think about your melatonin. It’s the hormone that makes you feel sleepy. Without it, you just don’t feel sleepy. It is released when you are in a dark environment. So let me ask you: are you going to bed with the TV on? Are you playing around on your phone in bed? Do you have a nightlight or bright lights in your neighborhood?

Do what you can to get rid of the light. Also, crank the temperature down in your room a few degrees. We fall asleep more easily when it’s about 67 degrees.

Should you take melatonin as a supplement? Probably not. Just do these things and it will balance itself. Research is now revealing that our production of melatonin not only governs our circadian rhythms, but plays a role in scavenging free radicals and supporting the immune system. We know that melatonin is crucial to health, but flooding your system with melatonin doesn’t automatically mean less free radicals and a better immune system. It’s all about melatonin balance.

Don’t discount the importance of sleep. Don’t be like so many of us who brush it off as something we can consistently de-prioritize. Enough sleep makes your waking life so much better.